Con: All Cardiac Arrest Patients Should Be Transferred to a Cardiac Arrest Center

Cardiac arrest centers (CACs) provide important critical expertise and advanced resources for select out-of-hospital cardiac arrest patients, and their role within regional systems of care is both intuitive and necessary. However, a universal transport strategy for all cardiac arrest patients to CACs is neither evidence-based nor system-efficient. Out-of-hospital cardiac arrest is a heterogeneous syndrome, and outcomes are driven predominantly by prehospital factors, patient characteristics, and arrest etiology. Existing data suggest that benefits associated with treatment at CACs are concentrated within specific subgroups, while indiscriminate transfer may delay stabilization, increase transport-related risk, preclude candidacy for advanced therapies, exacerbate rural-urban disparities, and strain finite critical care resources. A selective, triage-based approach to regionalization, prioritizing patients most likely to benefit from specialized care at CACs, may better optimize outcomes while preserving system resilience and equitable access to care.